Interventions of Hyperemesis after woman starts responding to therapy:

What do I teach my patient about Hyperemesis?

eat small, frequent meals consisting of low fat, high protein foodsavoid greasy and highly seasoned foodsincrease intake of potassium and magnesiumherbal teas may decrease nauseatake in fluids between meals rather than with meals helps to decrease nauseahave other family members cook if possible

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Dietary instructions for hyperemesis:

eat dry bland foodshigh protein small frequent mealscold foodsnack before bedtimedrink tea or water with lemonavoid high fat or spicy foods

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What is Ectopic Pregnancy?

A pregnancy in which the fertilized ovum is implanted outside of the uterine cavity, mainly in the fallopian tubes, but can also occur in the ovaries, abdominal cavity, and cervix.

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How is an Ectopic Pregnancy classified?

According to the site of implantation.Ex: tubal, cervical, abdominal, or ovarian

**The uterus is the only organ capable of containing and sustaining a term pregnancy.

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What does Ectopic Pregnancy look like?

If ectopic pregnancy ruptures....

pain increases.May be generalized, unilateral, or acute deep lower quadrant pain caused by blood irritating the peritoneumreferred shoulder pain can occur from diaphragmatic irritation caused by blood in the peritoneal cavity.signs of shock related to the amount of bleeding in the abdominal cavity and not necessarily vag. bleedingCullen sign: an ecchymotic blueness around the umbilicus

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How is Ectopic Pregnancy diagnosed?

Serum progesterone, B-hCG, Transvaginal ultrasound,

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How is Ectopic Pregnancy treated?

Quick treatment is the best treatment.

Recommended to remove the pregnancy by salpingostomy before rupture.general preop and post op carevital signs per protocol blood typerh factor

residual tissure is resolved with a dose of what?

Methotrexate

What is Methotrexate?

**Look up in drug book.** women recieving methotrexate should not take any analgesic stronger than acetaminophen-- may mask symptoms of tubal rupture.

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What is a hydatidiform mole?

A gestational trophoblastic disease (GTD)

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What are the two types of hydatidiform mole?

complete/classicpartial

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What causes hydatidiform mole?

unknown, but there may be an ovular defect or nutrition deficiency.women in early teens or over age of 40 OR any woman who has undergone ovulation stimulation

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Complete/classic hydatidiform mole:

results from fertilization of an egg, the nucleus of which has been lost or inactivatedThe sperm duplicates itself because the ovum has no genetic material.The mole resembles a bunch of white grapes.The hydropic(fluid filled) vesicles grow rapidly, causing the uterus to be larger than expected for the duration of pregnancy.usually contains no fetus, placenta, amniotic membranes, or fluidmaternal blood has no placenta to recieve it, leading to hemorrhage into the uterine cavity vaginal bleeding occurscan cause choriocarcinoma.

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Partial Hydatidiform mole:

chromosome studies often show a karyotype of 69, XXY; 69, XXX; 69, XYYThis occurs because two sperm fertilize an apparent normal ovum.often have embryonic or fetal parts and an amniotic saccongenital anomolies are usually presentpotential for malignant transformation is less than 6%

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What does Hydatidiform mole look like?

prune colored dischargeearly stages of complete mole cannot be distinguished from normal pregnancyvaginal bleeding occurs in 95%dark brown vaginal discharge (scant or profuse)significantly larger uterus than expected for pregnancy datesanemia from blood lossexcessive n/vabdominal crampspreeclampsiaany symptoms of gestational hypertension before 24 weeks is suggestive of molehyperthyroidismpulmonary embolization of trophoblastic elementspartial mole causes few symptoms and may be mistaken for a miscarriage**

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How do you treat Hydatidiform mole?

Most pass spontaneously, but D&C offers safe and rapid evacuation of mole.hysterectomy is possibleassessment provide woman and fam about the diseaseencourage to express feelings

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What do I teach my patient about Hydatidiform Mole?

pregnancy should be avoided for one year to void confusing signs of choriocarinoma with pregnancyany contraceptive is acceptable except intrauterine device.

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Follow up of Hydatidform Mole:

close observation for one yearpelvic exams and measurement of B-hCGrise tite and enlarging uterus are signs of choriocarcinoma.

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What is a miscarriage?

Spontaneous abortion-- a pregancy that ends without medical or surgical method before 20 weeks gestation or 500 gram birth weight *we use the term miscarriage because abortion to some patients seems harsh and insensitive.